Beyond the Incision: Pediatric Postoperative Sepsis Risk Patterns and Related Adverse Events in U.S. Inpatient Care

Background: Postoperative sepsis (POS) is a serious pediatric safety event tracked by the Agency for Healthcare Research and Quality's Pediatric Quality Indicator 10 (PDI 10). Purpose: This study examined POS in United States inpatient care. Methods: Using the 2019 Kids' Inpatient Database (KID), a nationally representative sample of U.S. pediatric discharges, we performed multivariable logistic regression to examine patient- and hospital-level predictors of POS. Results: Among approximately 5.24 million weighted discharges, 577,625 (12.65%) were flagged with POS. Key independent risk factors included undergoing major surgery, being treated in large urban teaching hospitals, and admission for surgical or injury-related care. Hospital characteristics such as Western region location, for-profit ownership, and large bed size were associated with increased POS odds, while rural and small hospitals showed protective effects. Race/ethnicity showed mixed findings; Native American and "Other" race patients had elevated POS risk, while Hispanic children had slightly reduced odds compared to White peers. Conclusions: Contrary to prior assumptions, neither age nor sex was a significant independent predictor. This study expands upon prior pediatric adverse event research by delineating the distinct risk profile of POS. The findings underscore the need for targeted infection control strategies in high-risk environments and support ongoing quality improvement efforts to reduce the surgical sepsis burden in children.